I have sharp stabbing pain under my right rib cage. What could be causing this?

Sharp, stabbing pain under the right rib cage can come from several organs and structures in that area, including the gallbladder, liver, lungs/pleura, ribs and chest wall muscles, or the intestines. The exact cause depends on details like timing, triggers (meals, breathing, movement), associated symptoms (nausea, fever, jaundice), and duration. Below are the most common possibilities, key clues to tell them apart, and when to seek urgent care.

Common Causes in the Right Upper Quadrant

• Gallbladder problems (gallstones, biliary colic, acute cholecystitis)

  • Typical features: Sudden, rapidly intensifying pain in the upper right abdomen or just below the breastbone; may radiate to the right shoulder or between the shoulder blades; often with nausea or vomiting. Pain can last minutes to hours for biliary colic and longer than 6 hours with acute cholecystitis, sometimes worsening at night or a few hours after a fatty meal. The right upper abdomen is often tender to touch. ^{[1] [2]}
  • Why it fits stabbing pain: The gallbladder can spasm when a stone blocks the duct, causing sharp, severe pain. ^[1]

• Liver conditions (hepatitis flare, liver cysts, masses)

  • Typical features: Dull or pressure-like discomfort or a sense of fullness under the right ribs; large cysts or masses can cause localized right upper pain; advanced disease may bring jaundice, weight loss, or a palpable lump. ^{[3] [4] [5] [6]}
  • Why it fits: While liver pain is often dull, enlarged or cystic lesions may cause focal discomfort under the right rib cage. ^{[4] [5]}

• Pleurisy (inflammation of the lung lining) or other pleural/lung issues on the right side

  • Typical features: Sharp pain that worsens with deep breathing, coughing, or sneezing; may ease when holding your breath; can radiate to the shoulder or back; sometimes associated with cough or fever. ^{[7] [8]}
  • Why it fits: The pleura sits right beneath the ribs; inflammation produces a knife-like pain with breathing. ^[7]

• Rib and chest wall causes (strained intercostal muscle, costochondritis)

  • Typical features: Tenderness to touch over a specific rib area; pain worse with twisting, turning, lifting, or certain postures; costochondritis often affects the front chest near the breastbone, but rib attachments on either side can hurt and mimic internal pain. ^{[9] [10] [11]}
  • Why it fits: Local musculoskeletal injury commonly causes sharp, pinpoint pain under the ribs, especially with movement. ^{[9] [10]}

• Intestinal causes (gas/bloating, duodenal ulcer, referred pain; less commonly appendicitis presenting atypically early on)

  • Typical features: Upper abdominal (epigastric) or right-sided pain that can be burning or cramping; appendicitis usually migrates to the right lower abdomen, but early pain may start near the upper mid-belly before moving down. ^{[3] [12] [13]}
  • Why it fits: Early or atypical patterns can confuse the location, but persistent migration to the lower right quadrant favors appendicitis. ^{[12] [13]}

How to Tell Them Apart

• Triggered by meals, especially fatty foods, with shoulder/back radiation and nausea: more suggestive of gallstones/biliary colic or cholecystitis. ^{[1] [2]}
• Worsens with deep breaths, cough, or sneezing and eases when holding your breath: points to pleurisy or pleural irritation. ^{[7] [14]}
• Pinpoint tenderness that is reproducible with pressing the area or with twisting/lifting: favors rib or muscle strain/costochondritis. ^{[9] [11]}
• Dull pressure/fullness with possible lump or swelling, or signs like jaundice: consider liver causes. ^{[5] [6]}
• Starts near the belly button or upper mid-abdomen and later shifts to the right lower side with increasing tenderness, ± fever/nausea: consider evolving appendicitis. ^{[12] [13]}

Red Flags: When to Seek Urgent Care

Seek immediate medical attention if you have any of the following with your right rib/upper abdominal pain:

• Severe or worsening pain that does not go away, or pain so bad you can’t find a comfortable position. ^{[15] [16]}
• Fever, persistent vomiting, or inability to keep fluids down. ^{[15] [16]}
• Yellowing of skin/eyes (jaundice), dark urine, pale stools. ^{[5] [6]}
• Chest pressure, shortness of breath, dizziness, or pain extending to the chest/neck/shoulder that raises concern for heart or lung emergencies. ^{[17] [15]}
• Bloody vomit or black/bloody stools. ^{[15] [16]}
• Marked belly swelling or severe tenderness to touch. ^{[17] [16]}

These can signal complications like acute cholecystitis, bile duct obstruction, severe infection, or another urgent condition that needs prompt evaluation. ^{[2] [15]}

What a Clinician May Do

• Physical exam to localize tenderness (right upper quadrant, rib, or chest wall) and check for signs like Murphy’s sign (pain on deep breath while pressing under right ribs) that suggests gallbladder inflammation. ^[2]
• Labs: complete blood count (infection), liver enzymes and bilirubin (bile duct obstruction or hepatitis), pancreatic enzymes if upper abdominal pain is broad. ^[5]
• Imaging:
  • Right upper quadrant ultrasound: first-line test for gallstones and gallbladder inflammation. ^[1]
  • Chest X-ray if pleurisy or lung issues suspected. ^[7]
  • CT scan if diagnosis remains unclear or appendicitis/other intra-abdominal causes are suspected. ^{[12] [13]}

Practical Self‑Care While You Arrange Care

• If you suspect gallbladder pain, avoiding fatty/greasy foods may reduce attacks while you await evaluation. ^[1]
• For musculoskeletal pain, gentle rest, heat or ice, and over-the-counter pain relievers (if safe for you) may help; avoid activities that aggravate the area. ^{[9] [10]}
• If breathing makes the pain worse or you have cough/fever, limit strenuous activity and seek prompt assessment to rule out pleurisy or infection. ^[7]

Summary

• Sharp right under-rib pain most commonly comes from gallbladder issues, pleural/lung irritation, chest wall strain, or less often the liver or intestines. ^{[3] [1] [2] [7] [9] [5]}
• Clues like relation to meals (gallbladder), breathing (pleurisy), movement/touch (muscle/rib), or systemic signs (jaundice, fever) help narrow the cause. ^{[1] [7] [9] [5]}
• Do not ignore red flags such as severe persistent pain, fever, jaundice, breathing problems, or gastrointestinal bleeding these require urgent care. ^{[17] [15] [16]}

If your pain is new, severe, or accompanied by any warning signs above, arranging an urgent in‑person evaluation is the safest next step. ^{[15] [16]}